WASHINGTON — The five biggest opioid manufacturers shelled out more than $10 million to patient advocacy groups, professional medical societies and affiliated individuals — who then “echoed and amplified” messages that encouraged use of those highly addictive drugs and set the stage for the current opioid epidemic.

That’s according to a new Senate committee investigation, released on Monday, which examined the financial ties between the pharmaceutical industry and outside groups over the last five years, from 2012 through 2017.

"I think these groups were cheerleaders too often ... cheerleaders for opioids," said Sen. Claire McCaskill, a Missouri Democrat who launched the probe last spring. McCaskill is the ranking Democrat on the Senate Homeland Security and Governmental Affairs Committee, a post she has used to investigate other drug-company practices.

Purdue was by far the largest donor to outside advocacy groups, which often bill themselves as grass-roots organizations supporting patients struggling with chronic pain. Among the recipients of drug company largesse: The U.S. Pain Foundation, the National Pain Foundation, and the Academy of Integrative Pain Management.

McCaskill said some of these organizations are doing good work on public policy. But others are "totally dependent" on drug companies for their funding, McCaskill said, and their advocacy is suspect.

"Our report indicates that in some instances they are merely fronting for these manufacturers, especially if you look at the lobbying they’ve done against restricting prescribing levels of opioids," she said.

The report charges that many of the advocacy groups, buoyed by drug company money, started undercutting state and federal efforts to curb opioid prescribing and using other "opioids-friendly messaging."

The report notes, for example, that the American Academy of Pain Medicine and the American Pain Society have promoted opioids as safe and effective for treating chronic pain and minimized the risk of addiction.

Purdue and other drugmakers "have a lot of explaining to do" for their contention that use of oxycodone "for patients in pain wouldn't lead to addiction," says Army Col. Chester Buckenmaier, an anesthesiologist and professor at the Uniformed Services University in Bethesda, Maryland. "We now know that’s not true and use these medications with more respect and more caution."

The report also notes that the American Academy of Pain Medicine and the Center for Practical Bioethics spoke out against the federal efforts to limit opioid prescribing. That effort was led by Centers for Disease Control and Prevention, which issued guidance in 2016 to doctors on when to prescribe opioid pain medication in primary care settings. The CDC recommended offering non-opioid therapies for chronic pain except in cases of active cancer treatment, palliative care and end-of-life care.

Some of the groups and their funders say there's a public health crisis being created by the response to the opioid epidemic. Chronic pain patients say they now have difficulty getting narcotics, which is often the only thing that can address their unremitting pain.

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Gov. Eric Greitens on Monday signed an executive order to create a statewide drug monitoring program in Missouri — the last state in the country to enact a system to track painkiller prescriptions.
Will Schmitt/Springfield News-Leader

"There are serious moral questions on both sides," says John Carney, executive director of the Center for Practical Bioethics in Kansas City, Mo. The opioid epidemic is "a national crisis, but there are lives ravaged by pain and that's a crisis too and should not be ignored."

As states moved to restrict the length and frequency of opioid prescriptions, drug companies and the patient groups fought back with aggressive lobbying campaigns.

Purdue Pharma, the maker of Oxycontin, said in a statement that it supported groups through annual dues and "unrestricted grants" when they were "interested in helping patients receive appropriate care."

Purdue also said it supports the CDC's guidance as "an important public health tool" and that it has been recommending it to doctors since it was released. And starting Monday, Purdue's employees would no longer visit doctors offices to pitch opioids and it would cut its salesforce by half to 200 people. The drugmaker's medical affairs staff will handle questions pertaining to the drugs, Purdue said.

McCaskill called Purdue's announcement "a major step forward" and said she believed the U.S. was starting to turn a corner on the opioid epidemic. But she said the Senate report was "the tip of the iceberg" in terms of how drug company money shapes health care policy debates and legislative outcomes.

Seeking legislation

She said she planned to pursue legislation that would force advocacy groups to disclose their funding sources.

"I’m not saying these groups can’t take funding from manufacturers," she said. "I’m saying the public needs to know about it. It needs to be clearly disclosed on their website."

Melissa Dye of Somerset, Ky. is shown with her late son Daris, who died in November 2015 of an overdose. "Cautious prescribing" could have prevented his death, she says.(Photo: Family photo)

The Senate report's findings are especially painful for Melissa Dye to hear as her son, Daris, died of an overdose of fentanyl and heroin about two years ago after he could no longer get Oxycontin prescribed.

For the advocacy groups, Dye says, "I would have one question: How would you feel if your child died of an overdose after being prescribed narcotics?" asks Dye. "It’s great that they don’t have the DNA that leaves them addicted, but why would they want the rest of us to risk it?

Dye says Daris was first prescribed Oxycontin as a 14-year-old after a sledding accident and again when he was 21 after he tore his rotator cuff in the Marines.

"I believe with all my heart that cautious prescribing would have saved my son," she says.

Dye, a nurse, says she's angry she was "lied to and in turn, I lied to hundreds of patients" when she said, ‘No, you cannot become addicted if you have true pain."

“In my opinion, my son should have never been prescribed OxyContin after hand surgery at the age of 14 or at 21 after a torn rotator cuff injury," says Dye,

Buckenmaier, program director of the Defense and Veterans Center for Integrative Pain Management, says opioid alternatives including non-steroidal anti-inflammatory drugs, acupuncture and massage have "really good documented science behind them with very minimal side effects."

Dye said she’s been a nurse in acute, long-term and critical-care settings, “And I find most people do not need narcotics," especially after they're educated on the risks and the alternatives.

Opioids prescribed too easily

During a recent hospitalization for pneumonia, Buckenmaier said the first thing he was offered was the opioid morphine. He asked for the injectable non-steroidal anti-inflammatory Toradol instead.

Pharmaceutical industry funding of his group in 2017 will probably be down to about 3% when it's fully calculated, he says.

Patient groups overall have been under fire for their drug industry funding and many have responded by reducing the percentage compared to other donors. But as Carney notes, "people are going to interpret what they interpret" when it comes to pharmaceutical influence.

The Senate report noted, for example, that the Academy of Integrative Pain Management and the American Cancer Society Cancer Action Network led an effort to protect a 2001 Tennessee law that made it difficult to discipline doctors for overprescribing opioids. Bob Twillman, the academy's executive director, said the law was more of "an imagined impediment than a real impediment" and his group wanted to revise it rather than repeal it.

Melissa Dye with her late son, Daris, who died of an opioid overdose in late 2015.(Photo: Family photo)

Dye is doing her part to fight industry influence. She started the nonprofit Project Daris, which stands for Drug Awareness Resources in Schools, and speaks at schools starting as early as kindergarten to get the message about the risks of opioids.

“We know that using narcotics at a young age changes the brain chemistry, and looking back, I can clearly see that’s exactly what happened to Daris,” she said. “He should have been taught mostly non-pharmaceutical therapies along with ibuprofen and potentially suffered with a little bit of pain.”